Late Breaking Abstract - Effectiveness of multimodal remote patient monitoring at CPAP initiation in Obstructive Sleep Apnea (OSA) with high cardiovascular risk: A randomized trial

Background: OSA management must target not only increasing adherence to continuous positive airway pressure (CPAP) but should also include strategies aimed at reducing blood pressure and increasing physical activity. Objective: To evaluate the effectiveness of an integrated intervention using remote patient monitoring (telemonitoring) in reducing arterial blood pressure (BP) in high cardiovascular risk OSA patients. Methods: In a multicenter, open, randomized trial, OSA patients were randomly assigned at time of CPAP initiation to usual care vs multimodal telemonitoring for 6 months. Telemonitoring used electronic equipment that collected information about BP, symptoms, CPAP side effects, oximetry and steps per day. Home care providers conducted telemonitoring reviews and protocolized actions. The primary effectiveness outcome was assessed using home self-measured BP (HBP) (3 consecutive days, 10 to 18 measurements). Secondary outcomes included CPAP compliance, symptoms and steps per day. Results: Of 306 patients (mean age 60 [SD, 9.5] years; 227 [74 %] men; mean BMI 33 [SD, 6.3] kg/m2; mean AHI 50/hour [SD, 20]), 149 received usual care and 157 telemonitoring. The intervention and usual care groups did not differ significantly in 6 months home self-measured BP. In secondary analyses, there were no significant differences in steps per day or symptoms, but there was a significant difference in CPAP compliance in favor of the telemonitoring arm (-0.53 hour (95% CI: -1.05; 0.00), p=0.05). Conclusion: In OSA patients with high cardiovascular risk, multimodal telemonitoring did not improve HBP but increase CPAP adherence.